Teams at Centene Corporation

Support clinical policy by reviewing and coding Clinical Coverage Guidelines and Claims Edit Guidelines, maintaining authorization management tools, conducting regulatory and coding research, liaising with vendors and cross-functional teams, and serving as a coding and claims payment subject-matter expert for medical management and implementation projects.

Provide clinical and operational support for utilization and case management by developing, implementing, and monitoring clinical guidelines, policies, SOPs, and regulatory notices. Measure workflow effectiveness, run basic reports, research best practices, create documentation and training materials, and collaborate with leadership, medical directors, and stakeholders to ensure compliance, quality improvement, and efficient implementation of clinical processes.